Endocrine Abstracts

A 64 old year old obese (BMI 31 kg/m²) Caucasian male was admitted to our hospital with general malaise, nausea, vomiting and dehydration. He gave no preceding history of polyuria, polydipsia or weight loss. He had been receiving oral corticosteroids for established ulcerative colitis. He was found to have random plasma glucose of 70.7 mmol/l, positive serum and urine ketones, and metabolic acidosis with PH 7.27, bicarbonate 13 mmol/l and base excess −12.4. There was no clinical evidence of sepsis or lactic acidosis. He was managed according to the hospital protocol for Diabetic Ketoacidosis (DKA).

His C-peptide was 1115 pmol/l (NR 120–600) when his glucose was 25 mmol/l. Although he presented with DKA, he had features of metabolic syndrome, including high BMI, high C peptide and age group more in keeping with type 2 Diabetes Mellitus. It is likely that the high dose of steroids he had, for his inflammatory bowel disease precipitated the DKA, which in this case has been a rare presentation for Type 2 diabetes mellitus.

He was started on basal bolus insulin regimen. Current HbA1c is 5.0% few months after presentation. His steroids have been stopped, he has good control of his inflammatory bowel disease with mesalazine. His insulin is being tapered, metformin has been started and the plan is to stop insulin altogether when his insulin daily requirements are significantly diminished.